Orthopade最新文献

{"title":"[Radiosynoviorthesis of the thumb's carpometacarpal joint].","authors":"Clemens Mingels, Keivan Daneshvar, Ali Afshar-Oromieh","doi":"10.1007/s00132-021-04194-6","DOIUrl":"10.1007/s00132-021-04194-6","url":null,"abstract":"<p><p>Radiosynoviorthesis (RSO) is an established therapeutic method for the local treatment of pain in aseptic joint inflammation (e.g. arthritis, activated osteoarthritis, synovitis). RSO can be used for the treatment of synovial membrane inflammation of the finger joints such as the thumb's carpometacarpal joint. The beta emitter Erbium-169 (Er-169) is injected into the joint space, which irradiates the inflamed synovialis, thereby leading to fibrosis and obliteration of the pain receptors of the synovial membrane. The chances of success in the treatment of the thumb's carpometacarpal joint by RSO are estimated to be 54-100% within 2-6 weeks after therapy.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39618368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thumb Arthritis - an update].","authors":"Frank Unglaub, Christian K Spies","doi":"10.1007/s00132-021-04204-7","DOIUrl":"10.1007/s00132-021-04204-7","url":null,"abstract":"","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39829476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Conservative treatment options for symptomatic thumb trapeziometacarpal joint osteoarthritis].","authors":"Florian Falkner, Mahmut Arman Tümkaya, Benjamin Thomas, Amir K Bigdeli, Ulrich Kneser, Leila Harhaus, Berthold Bickert","doi":"10.1007/s00132-021-04195-5","DOIUrl":"10.1007/s00132-021-04195-5","url":null,"abstract":"<p><strong>Background: </strong>There are numerous non-surgical treatment options for basal thumb osteoarthritis (OA).</p><p><strong>Objectives: </strong>Aetiology, clinical appearance and diagnosis of basal thumb OA, explanation of the individual non-surgical treatment options, presentation of the current state of studies.</p><p><strong>Material and methods: </strong>Search for case analyses, studies, systematic reviews and meta-analyses using PubMed and LIVIVO.</p><p><strong>Results: </strong>Intraarticular injections have no more than short-term success with the risk of infection, which should not be underestimated. Radiotherapy seems to be an effective treatment, but little research has been done on this. Physiotherapy and splinting treatment promise long-term improvement of clinical symptoms and hand function.</p><p><strong>Conclusion: </strong>Basal thumb OA is a common and serious condition, which in the case of continuous pain should be diagnosed and treated adequately. A multi-modal therapeutic regimen with avoidance of repetitive intra-articular injections seems to provide the best long-term results.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"2-8"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39840064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hemitrapeziectomy of the carpometacarpal joint of the thumb].","authors":"A Zach, S Dikou, G Wassilew, M Lautenbach","doi":"10.1007/s00132-021-04193-7","DOIUrl":"10.1007/s00132-021-04193-7","url":null,"abstract":"<p><strong>Background: </strong>Hemiresection arthoplasty or partial trapeziectomy of the carpometacarpal joint of the thumb is a surgical option in stages 1-3 according to Eaton-Littler classification. Preservation of the intact scaphotrapeziotrapezoidal (STT) joint and maintenance of the length of the thumb is the advantage of this technique.</p><p><strong>Technique: </strong>Technically, partial trapeziectomy is only slightly more complex compared to trapeziectomy with or without suspension. An interposition of autologous or allogeneic material is recommended; suspension arthroplasty is also possible in almost all common variants. Despite these theoretical advantages, this technique has not proven advantageous in practice, neither in terms of function nor in terms of time, compared to other techniques. The great advantage of partial trapeziectomy, however, is the wide range of options for revision surgery in the case of persistent complaints.</p><p><strong>Results: </strong>The risk of proximalization of the thumb due to an inadequate interposition is generally minor and is usually caused by implant sintering. This can easily be compensated for by implanting a larger graft. Persistent instabilities are the most common cause of persistence of symptoms and can usually be remedied by autologous or allogeneic suspension arthroplasty. In addition, the entire range of endoprosthetics is also possible with a previous spare resection of the trapezium and the possibility of a complete trapeziectomy remains in any case. The obvious theoretical advantages of arthroscopic hemitrapeziectomy need to be confirmed in practice in future.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"23-28"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39618369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Manual addition of antibiotics to industrial bone cement mixes : Investigations of the dry mix in the cement cartridge during manual admixture to polymer-active substance mixtures].","authors":"Mustafa Citak, Stefan Luck, Philip Linke, Thorsten Gehrke, Klaus-Dieter Kühn","doi":"10.1007/s00132-021-04115-7","DOIUrl":"10.1007/s00132-021-04115-7","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic infection (PPI) is a rare but serious complication. An elementary component of the therapy of PPI is the use of bone cement with the addition of antibiotics. For targeted therapy, manual mixing of antibiotics with industrially produced bone cement mixtures is often necessary. Possible problems resulting from manual mixing have not been described sufficiently so far.</p><p><strong>Objectives: </strong>Therefore, the aim of the present study was to describe the influence of the additional homogenisation by dry mixing of a polymer-active substance mixture on the quality of manually added cement.</p><p><strong>Material and methods: </strong>In the laboratory-based study, four cement samples were prepared using different methods for manual addition and homogenisation of antibiotics (vancomycin). The reference control was Copal® G + V (Heraeus Medical GmbH, Wehrheim, Germany), to which the vancomycin (V) had already been industrially added. The samples were then examined for mechanical, microbiological and microscopic parameters.</p><p><strong>Results: </strong>In the mechanical and microbiological results, no statistically significant differences were found between the manually added mixtures and the reference. After dry mixing of the polymer powder, the inner surface of the mixing cartridges used showed signs of scratching in the microscopic examination and showed indications of abrasion during mixing.</p><p><strong>Conclusion: </strong>The manual addition of antibiotics to industrially produced bone cement should be reserved for selected indications if the bone cement mixtures produced by industry are not sufficient.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"44-51"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39014942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Resection arthroplasty for thumb basal joint arthritis].","authors":"Ali Ayache, Christian K Spies, Frank Unglaub, Martin F Langer","doi":"10.1007/s00132-021-04200-x","DOIUrl":"10.1007/s00132-021-04200-x","url":null,"abstract":"<p><p>Due to the crucial role of the thumb for gripping, osteoarthritis of the first carpometacarpal joint leads to a substantial impairment of hand function. There are effective nonoperative and joint-preserving surgical treatment options for early stages of the disease. In advanced cases, after exploiting conservative treatment, carpometacarpal thumb arthrodesis or arthroplasty may be indicated in selected cases but trapeziectomy with or without interposition or suspension constitutes the gold standard surgical procedure. This reliably provides favorable results, irrespective of the technique, with pain relief, good physical function, excellent patient global assessment and low complication rates.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"51 1","pages":"65-78"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39664402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Are the results of total knee arthroplasty after high tibial osteotomy worse?]","authors":"Marcel Mäder,&nbsp;Franziska Beyer,&nbsp;Cornelia Lützner,&nbsp;Jörg Lützner","doi":"10.1007/s00132-021-04134-4","DOIUrl":"https://doi.org/10.1007/s00132-021-04134-4","url":null,"abstract":"<p><strong>Background: </strong>In some cases, total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is necessary. HTO can adversely affect anatomy and alignment resulting in more complicated and challenging TKA surgery. The aim of this study was to investigate whether patients having undergone HTO benefit from TKA to the same extent as patients with primary osteoarthritis of the knee.</p><p><strong>Methods: </strong>A total of 44 patients after HTO and 1703 patients with primary osteoarthritis of the knee were identified in the local registry. To reduce confounders, a 1:1 propensity score matched-pair analysis (age, gender, BMI, comorbidities) was carried out in patients with a 5-year follow-up. This resulted in 35 matched pairs, which were compared for knee function, pain level, satisfaction and perioperative data (operative time, implant type, complications) and revisions.</p><p><strong>Results: </strong>Patients having undergone HTO had no significant differences in knee function prior and 5 years after surgery but a significantly higher pain level. Despite the higher pain level before and after TKA, there was a similar satisfaction with the result of the surgery. The operative time for TKA was significantly longer after HTO and modular implants with stem and wedges were used significantly more often. The two cohorts did not differ with respect to complications within the first 3 months after surgery. The revision rate within 5 years was not increased in patients after HTO.</p><p><strong>Conclusion: </strong>Patients having undergone HTO achieved a similar knee function in comparison to patients with primary osteoarthritis of the knee after TKA. However, a higher pre- and postoperative pain level was recorded in patients following HTO. The surgical effort was significantly higher after HTO.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1026-1031"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00132-021-04134-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Bone defect management in revision knee arthroplasty].","authors":"Eric Röhner, Markus Heinecke, Georg Matziolis","doi":"10.1007/s00132-021-04181-x","DOIUrl":"10.1007/s00132-021-04181-x","url":null,"abstract":"<p><strong>Background: </strong>In 2019, 124,677 primary total knee arthroplasties and 14,462 revision TKA were performed in Germany. This corresponds to a percentage of 11.6%. According to the EPRD, the probability of further revision surgery after the first exchange operation is around 15%.</p><p><strong>Reasons: </strong>The most common reason for revision surgery is still aseptic loosening with 23.9%. One possible cause could be the difficult fixation of revision total knee arthroplasty. If the bone quality is insufficient, cement-free or cemented diaphyseal anchoring of the prosthesis is often not sufficient to ensure adequate fixation. As a rule, defect management and fixation of the implant are based on the defect situation and the quality of the bone. Therefore, revision total knee arthroplasties based on the fixation principle of Jones et al. should be sufficiently fixed in at least 2 zones.</p><p><strong>Techniques: </strong>There are various techniques for stable anchoring of revision implants. In addition to cemented or cementless stem anchoring, bone allografts, wedges and blocks and, in recent years, cones and sleeves have become increasingly popular. In the present work, the various options for a stable anchoring of revision implants are presented and evaluated. In addition, the clinical and radiological outcome of cones vs. sleeves in bone defect management in revision knee arthroplasty will be compared.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1004-1010"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39522250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imageless robotic-assisted revision arthroplasty from UKA to TKA : Surgical technique and case-control study compared with primary robotic TKA.","authors":"Lars-Rene Tuecking,&nbsp;Peter Savov,&nbsp;Henning Windhagen,&nbsp;Simon Jennings,&nbsp;Dinesh Nathwani,&nbsp;Max Ettinger","doi":"10.1007/s00132-021-04182-w","DOIUrl":"https://doi.org/10.1007/s00132-021-04182-w","url":null,"abstract":"<p><strong>Background and objective: </strong>It is evident from the national joint registries that numbers of revision knee arthroplasty operations are rising. The aim of this article is to introduce a new robotic-assisted approach in UKA to TKA revision arthroplasty and investigate the alignment accuracy, implant component use and surgery time and to compare it to primary robotic-assisted TKA arthroplasty.</p><p><strong>Methods: </strong>This retrospective, case-control study included patients undergoing image-less robotic-assisted revision arthroplasty from UKA to TKA (n = 20) and patients undergoing image-less robotic-assisted primary TKA (control group, n = 20) from 11/2018 to 07/2020. The control group was matched based on the BMI and natural alignment. Comparison of groups was based on postoperative alignment, outlier rate, tibial insert size, lateral bone resection depth, incision-to-wound closure time. All surgeries were performed by a single senior surgeon using the same bi-cruciate stabilizing TKA system. Statistical analysis consisted of parametric t‑testing and Fisher's exact test with a level of significance of p < 0.05.</p><p><strong>Results: </strong>The two groups showed no differences in mean BMI, natural alignment (p > 0.05) and mean overall limb alignment. No outlier was found for OLA and slope analysis. The smallest insert size (9 mm) was used in 70% of the cases in the revision group (n = 14) and in 90% of the cases in the primary group (n = 18, p = 0.24), distal femoral and tibial resection depth showed no statistical difference (p > 0.05). The incision to wound closure time was longer in the revision group but showed no significant difference.</p><p><strong>Conclusion: </strong>Image-less robotic-assisted revision arthroplasty from UKA to TKA showed a comparable surgery time, and alignment accuracy in comparison to primary robotic-assisted TKA. Comparable bone preservation and subsequent tibial insert size use was observed for both groups.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1018-1025"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39574005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Revision TKA due to instability: diagnostics, treatment options and outcomes].","authors":"Martin Faschingbauer, Heiko Reichel","doi":"10.1007/s00132-021-04179-5","DOIUrl":"10.1007/s00132-021-04179-5","url":null,"abstract":"<p><strong>Background: </strong>Instability after primary TKA is a frequent reason for revision surgery. Other mechanisms of failure must be ruled out before an in-depth analysis of instability.</p><p><strong>Diagnostics: </strong>Diagnostic tools for instability consist of medical history, clinical examination, and imaging. The clinical examination must focus primarily on the extent of the instability, the location of the instability and the levels of instability. Varus and valgus stress radiographs in the mediolateral plane in extension and flexion, as well as anteroposterior stress images (drawer) are mandatory. In addition, the underlying cause (or a combination of causes) must be defined. Possible causes include malalignment, component malposition (rotation), bony and ligamentous insufficiencies and implant-associated instabilities.</p><p><strong>Therapy: </strong>Once the mechanism of failure is understood in detail, various therapeutic options are available. Conservative therapy is only considered in patients where there is borderline instability, and the patient has adequate compensatory options in daily life. Some authors postulate the need for 3 months of conservative therapy in every case before possible surgery. Isolated inlay exchange is usually only a compromise and shows failure rates of up to 60%. Partial component exchange requires some preconditions and is technically demanding.</p><p><strong>Results: </strong>If the indication is correct, the results are consistently comparable with those after full component revision. In the case of full component revision, attention must be paid to the degree of constraint to achieve stability but also to avoiding over-treatment (too highly constrained TKA with an probability of loosening). In general, the results after revision surgery are worse in cases of instability than in cases of exchange surgery due to aseptic loosening or patellar abnormalities but better than in cases of infection or arthrofibrosis.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"979-986"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39562188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}